Active NPI
Thomas Andrew Buckley, ED.D., ATC
- Athletic Trainer
- Statesboro, GA
National Provider Identifier
1194924449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT001415
- Practice address
- Georgia Southern University
Health & Kinesiology
Statesboro, GA 30460-0001 - Phone
- (912) 681-5268
- Fax
- (912) 681-0381
- NPI assigned
- Jul 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT001415 | GA | Primary |
Addresses
Primary practice location
Georgia Southern University
Health & Kinesiology
Statesboro, GA 30460-0001
Mailing address
Georgia Southern University
Health & Kinesiology - P.O. Box 8076
Statesboro, GA 30460-8076
Phone (912) 681-5268
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT001415 | GA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184630400000",
"number": "1194924449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "GEORGIA SOUTHERN UNIVERSITY",
"address_2": "HEALTH & KINESIOLOGY - P.O. BOX 8076",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304608076",
"telephone_number": "912-681-5268",
"fax_number": "912-681-0381"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "GEORGIA SOUTHERN UNIVERSITY",
"address_2": "HEALTH & KINESIOLOGY",
"city": "STATESBORO",
"state": "GA",
"postal_code": "304600001",
"telephone_number": "912-681-5268",
"fax_number": "912-681-0381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKLEY",
"first_name": "THOMAS",
"middle_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "ED.D., ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-17",
"last_updated": "2007-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "GA",
"license": "AT001415",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesboro, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.